Crowd shouts down Lake Placid ER plan

May 2, 2013

LAKE PLACID - Adirondack Health officials faced a hostile crowd Wednesday at the first of two public meetings on their plan to convert the emergency room at Adirondack Medical Center-Lake Placid to an urgent care center.

Local residents, some of whom were just plain angry, voiced strong objections to the proposal during the 90-minute meeting at the Lake Placid Center for the Arts. They said the change would leave the community vulnerable and put a strain on the emergency medical service system. Some questioned Adirondack Health's rationale behind shifting to an urgent care clinic - or an "immediate care center," as the organization is now calling it.

"I think your logic is flawed," said Karen Huttlinger, keying in on an argument by Adirondack Health officials that the Lake Placid ER isn't busy enough to justify being open around the clock. "You're not talking about Burger King where, 'We're not selling enough burgers during these hours, so we're going to close.' It's more like a fire department or an electric department where you're setting up for peaks. Those five people who come in on any given day from 3 in the morning to 6 in the morning, they need an emergency room and they need one quickly. They're people, not burgers."

Article Photos

Lake Placid resident Judy Lundin, left, speaks Wednesday night at a public meeting at the Lake Placid Center for the Arts on Adirondack Health’s plan to make the emergency room at its Lake Placid hospital an urgent care clinic. Dr. Herbert Bergimini, center, and Karen Huttlinger wait in line to speak.(Enterprise photo — Chris Knight)

Adirondack Health CEO Chandler Ralph, center, talks to the crowd at a public meeting Wednesday night at the Lake Placid Center for the Arts on the proposed conversion of the Adirondack Medical Center-Lake Placid emergency room to an urgent care center. Also pictured are Stan Urban, left, chair of Adirondack Health’s Board of Trustees, and Chief Medical Officer Dr. John Broderick.(Enterprise photo — Chris Knight)

Members of the Lake Placid Volunteer Ambulance Service also spoke out against the proposal.

"I know for a fact that (the Lake Placid) ER has saved lives," said Chris, a six-year veteran of the service who didn't give his last name. "I've seen it firsthand."

If Lake Placid ambulances have to travel more often to the Saranac Lake ER, he said it increases the amount of time that a crew will be out of service from 40 minutes to two hours, which would strain the mutual aid system. Of the service's 1,400-plus calls last year, 568 - about 40 percent - were transports to the Lake Placid ER. (Editor's note: The numbers in the previous sentence have been corrected.)

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"It's going to hurt our ambulance service here in town," he said. "It's not just going to hurt us on the inability to get to you fast enough. It's going to hurt us financially. You're going to stress us to the max."

Dr. John Broderick, Adirondack Health's chief medical officer, said figuring out "how to make this work" with local EMS agencies is still a work in progress.

"That's a complex puzzle that I'm not going to pretend to say that we have it solved," he said. "Unequivocally, if the boad makes a decision, we'd have to hammer that out."

Melissa, a critical-care technician with the ambulance service, said she is "pretty ticked off" about the proposal. She said the Saranac Lake ER is too busy to handle the increased number of people who will no longer be taken to the Lake Placid ER.

Broderick said 90 percent of the volume at the Lake Placid ER is "care that could perhaps be done at another facility.

"We don't anticipate all that volume, most of which is not critical, to actually land and end up in Saranac Lake," he said. "There will be a certain amount of increase, and we're going to staff and plan appropriately for that."

Broderick also said the emergency department in Saranac Lake typically is not consistently full.

"Come on, Dr. Broderick," Melissa fired back. "You have half the Lake Placid ambulance squad here plus all the nurses from the ER. Do you think we're stupid? Saranac Lake is slammed all the time."

Patty Rascoe asked if Adirondack Health officials realize they'll lose a lot of revenue if residents in Lake Placid, Keene and Wilmington go to other hospitals like Champlain Valley Physicians Hospital in Plattsburgh and Elizabethtown Community Hospital.

"That may be the case, and in our financial modeling we predicted a loss of volume," said Stan Urban, chairman of Adirondack Health's Board of Trustees.

Rascoe asked if the hospital property would be turned over to the town of North Elba, referencing a 1990 agreement that gives the town first option on the property for $10 if around-the-clock emergency room care in the community should end.

"That's the town's call," Urban said. "We recognize that if we make this change, the town has every right to take over ownership of the property. I would hope we could work out an orderly transition with the town, whether it involves rent, whether it involves an opportunity to relocate and build buildings on the Uihlein (nursing home) campus."

Former North Elba Supervisor Shirley Seney said she was worried about the young athletes who compete and train in the area.

"We've got to have a medical facility here that is going to be able to offer what's needed to the young people and their followers in getting medical treatment when it's needed quickly, not another 12 miles away in an ambulance or a motor vehicle," she said. "I say, leave us alone. Let us have our emergency room."

Dr. Herbert Bergimini said the board needs to hold a similar meeting in the summer when seasonal residents are here. He said they should have a stake in the decision.

"We definitely need an emergency service here, 24-7," he said.

No one spoke in favor of the Adirondack Health proposal, although another local doctor, Howard Novick, urged the crowd to put the issue in context.

"I don't think you really understand the decimation that's come on to medical care in the last decade," he said. "It's just been a constant decline and decline. No one's doing this out of malicious intent."

Novick also noted that Adirondack Health's Board of Trustees is made up of "local people who really mean well."

Adirondack Health CEO Chandler Ralph ended the meeting at 7:30 as the LPCA needed the space for a rehearsal, but that didn't sit well with the crowd.

"That's awful convenient," one woman shouted.

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Changing landscape

During a presentation at the outset of the meeting, Ralph put the proposal in the context of a "changing landscape" for health care organizations across the country. She said her organization has seen, and is expecting more, financial losses due to the Affordable Care Act, the shift to more home-based and preventative medical care and a transition toward outpatient services.

"Health care is changing fundamentally," she said. "The way it was 10 years ago or even five years ago is vastly different than how it's going to be in the future, and the only people and systems that are going to survive are those that can change quickly, that are nimble, that are flexible and can respond."

Ralph said after the meeting that she expected people would speak passionately about the ER issue.

"I respect their opinions," she said. "It's our responsibility to listen to those opinions but also to educate on how drastically health care is changing."

Another Adirondack Health-hosted meeting on the proposal is set for 7 p.m. on May 8, also at the LPCA.

Urban said he expects a decision will be made at the board's next meeting, May 30.

"At this point, we've been discussing this and having meetings for the last three months," he said. "I'm not sure more time will do anybody any favors in terms of delaying which way we're going. I think the community needs to know."